Hi Marchlove, sorry to be so late replying. A busy week. Sorry too that my lengthy, question strewn last post post made for a lot to deal with. It's just that detail can be important when the combination of hypothyroidism & menopause can make for a tangled mess, needing a magnifying glass to unravel! When I said about learning as much as poss I certainly didn't mean from me, but from reputable published sources & any expert medics we're lucky enough to encounter. Like most of us here, I'm very much still learning. And, no of course I don't mind questions.
Interested to know that your BMI is low like mine. That's one of the frustrating features that prevented me getting diagnosed in the first place & later getting tested for the conversion defect. No-one thinks of hypothyroidism as a possibility in skinny people. My first Endocrinologist told me that in fact many patients are underweight, confirming my intuition that my typically hypothyroid sluggish digestive tract was not helping me gain weight. It can be hard for us to eat enough weight promoting foods when food is so slow to move through, requiring a very high fibre diet that's by its nature not very calorific. It seems to be increasingly thought that when untreated hypothyroidism does cause weight gain, much of that is due to fluid retention rather than fat.
Unfortunately, being underweight can also slow down the metabolism as the body strives to conserve calories for essential functions. Getting the right thyroid balance is even more tricky for us because we need to take great care not to become overtreated on thyroid replacement, which could cause further weight loss we really can't afford. Not that there's
anything good about being overtreated. You'll know that this can have serious adverse effects on bones & cardiovascular system if it goes on for any length of time. I'm sorry I keep stressing that in posts but anyone on replacement needs to be aware of it.
So we need to be very careful not to let our TSH go too low nor our T3/T4 too high. Can I ask has your BMI ever been significantly higher & if so were your symptoms such as coldness, fatigue & constipation less of a problem then? Wondering whether gaining weight might help your symptoms, if you can do so healthily. I just can't gain much & keep it on so I sympathise if you're the same.
Like you, I also feel worse on high doses of oestrogen & bloods have repeatedly shown that despite being on transdermal, these increase my need for thyroid hormone & that conversely, when my oestradiol dose/blood level goes down, my thyroid replacement needs tweaking downwards.
Do you decrease your dose in summer and increase in the winter?
No I don't, but my thyroid meds have been a work in progress while trying to find my best HRT fit, so they have been frequently changed according to my blood results & symptoms, whatever the season. I discussed seasonal variation with my Endocrinologist some years ago as I know some sources favour it, but he doesn't believe it's necessary.
Thanks for the ref ranges for your latest test. I see the FT4 range doesn't go up as high as it does with the lab that does my testing, so your last FT4 result isn't as low down the range as I thought, which probably explains why your TSH looks fine.
How many times a year do you test?
Before HRT when my thyroid levels were more stable I used to have TFTs on the NHS every 3 months as my then GP preferred that frequency, though that's more often than is usual for patients established on thyroid replacement. But I was never well on Thyroxine alone & my levels were not that stable, so it made sense to keep an eye on it. Now my thyroid care is necessarily private as the NHS won't monitor T3 replacement, so I time tests to have results ready for reviews, which are currently roughly every 3 months. If I feel my dose is wrong in the interim I tweak it myself & my Endo is happy with that as he knows I understand how it works & have been on replacement long enough to know how I feel when my dose is wrong either way. That said, HRT that's a work in progress can make for a confusing picture.
My Thyroxine is compounded hence the 60mcg dose but I’m actually now on 72.5mcg as I’m adding half an Nhs tablet, which Endo said was ok to do because I’d started to feel cold.
So you're adding half a 25mcg tablet to your compounded T4. Do you know you can get 12.5mcg Thyroxine on the NHS? TEVA brand make it & these are scored so can be halved to give just over 6mcg for fine tuning. Have you ever been on standard thyroid replacement, as opposed to compounded? Would be cheaper for you.
I consistently have haematocrit and haemoglobin over the reference range, do you know what your red blood cell levels are? I’ve seen a haematologist but he doesn’t seem to know why either.
Again like you, my MCH (haemoglobin) is usually slightly high & my last RBC was at bottom ref range. There can be various reasons for high MCH, including low B12 as you'll know & also being a bit dehydrated. If bloods are done early morning it's possible fluid levels are suboptimal if we haven't yet drunk enough to compensate for fluid loss overnight, so that could skew the haemoglobin result. I expect you've already looked into that, but the link here is interesting for anyone in a similar situation.
https://www.medicalnewstoday.com/articles/318050I suppose I could try increasing estrogen to see if that helps with my aches, but I’m a bit loath to do so as my mood is good and higher doses make me anxious.
I think it makes sense not to increase if you feel better on less. If you can establish what dose of thyroid replacement works best with your current HRT then over time hopefully you'll feel better.
I take on board what you say about the increased thyroxine might help increase my FT3, but I will talk to my Endo about it and let you know what she says.
Yes, I meant the increase you said you'd already made - please don't increase further without discussing with your Endocrinologist. The extra 12.5mcg daily you've added might actually prove too much as your last TFT looks OK-ish, just the T3 a bit low together with the concern over the possibly related residual symptoms - the fatigue, coldness, constipation. A small tweak to T4 dose can change levels quite a bit over time.
How does one feel if one’s FT3 is optimal??
It's a long time since my FT3 has looked optimal on paper - it's always below range. T3's short half life means on a low dose, not much is left if the TFT is done 8 hours or more after last dose - my Endocrinologist's preferred conditions. But when I was first on T3 many years ago, a higher dose than my body can tolerate now, the most noticeable effect was like having someone flick a switch to start up my digestion & remarkably soon after commencing T3. It was a huge relief to start to feel well. I just felt more normal in every way. If replacement is suboptimal in any way we can continue to have some of the many hypothyroid symptoms & if we need T3 & can find the right dose to balance with T4, those should improve/resolve. But it can be tricky to balance the 2 & trickier with HRT in the mix in my experience & judging by posts from the few other members who are on T4+T3 & HRT. Most hypothyroid patients don't need to take T3 as their body's conversion of Thyroxine is efficient enough to provide all they need. Only about 15% are said to need T3 as well.
I hope your appointment goes well.
Wx
Author
Topic: Interpreting thyroid function tests (Read 5308 times)